Provider Demographics
NPI:1174550404
Name:JAI CHAMUNDA MILLER INC
Entity type:Organization
Organization Name:JAI CHAMUNDA MILLER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BHAVESH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-741-3604
Mailing Address - Street 1:206 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49094-1154
Mailing Address - Country:US
Mailing Address - Phone:517-741-3604
Mailing Address - Fax:517-741-7812
Practice Address - Street 1:206 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:MI
Practice Address - Zip Code:49094-1154
Practice Address - Country:US
Practice Address - Phone:517-741-3604
Practice Address - Fax:517-741-7812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010043343336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI310320Medicaid
MI3428160Medicaid
MI0-A2-0255OtherBXBS/BCN
MI0-A2-0255OtherBXBS/BCN